The Burden of HIV, Hepatitis B and Hepatitis C by Armed Conflict Setting: The Nigeria AIDS Indicator and Impact Survey, 2018

Abstract

Background: Against a background of security challenges, Nigeria conducted recently the largest population-based HIV survey in the world to ascertain the burden of the HIV disease in the country. Objective: We evaluated the main outcomes of the survey and the level of success using participation/response indicators. Methods: The survey was conducted from July–December 2018 by over 6,000 field staff across Nigeria in six consecutive webs, using two-stage cluster sampling. We estimated the prevalence of HIV, hepatitis B and hepatitis C in the entire country and by conflict zone status. Adjusted odds ratios (OR) and 95% confidence intervals (CI) from survey logistic regression models were used to compare the likelihood of test positivity for the three infections between zones. Findings: A total of 186,405 adults were interviewed from 97,250 households in 3,848 census enumeration areas. The overall HIV, hepatitis B and hepatitis C positivity rates were 1.55%, 7.63% and 1.73%, respectively. The prevalence of HIV, hepatitis B and C infection was significantly greater in conflict than non-conflict zones (HIV: 1.75% versus 1.0%; hepatitis B: 9.9% versus 7.3%; and hepatitis C: 3.2% versus 0.3%; p < 0.01 in all cases). Individuals living in conflict zones were about three times as likely to test positive for HIV (OR = 2.80, 95% CI = 2.08, 3.60) and nearly six times as likely to test positive for hepatitis C (OR = 5.90, 95% CI = 2.17, 16.67). Conclusion: Large population-based surveys are feasible, even in armed conflict settings. The burden of HIV, hepatitis B and hepatitis C was significantly higher in areas of conflict in Nigeria, highlighting the need for reinforced public health control measures in these settings in order to attain UNAIDS’ 95-95-95 targets of controlling the HIV epidemic in sub-Saharan Africa by 2030.

Unified European support framework to sustain the HIV cascade of care for people living with HIV including in displaced populations of war-struck Ukraine

“…Ensure the identification of people with HIV, considering Ukrainian key populations with a high HIV prevalence [38][39][40][41][42] Registration of patients (including refugees) in need of ART; a proactive approach by health-care providers to identify those with HIV in key populations and overcome stigma; sufficient operational HIV expert teams on the ground; medical outreach teams to reach remote areas or areas without operational clinics because of warfare…”

“…Studies have shown that the HIV prevalence in people displaced from HIV endemic settings is high. [38][39][40][41] With the focus of the war now in the eastern, southern, and central parts of Ukraine, the population of people with some of the highest HIV infection rates in the country is affected and deprived of access to harm-reduction programmes, resulting in a high chance of viral spread because of migration internally and internationally. 10,62 Convincing evidence exists that adequate HIV treatment and linkage to care programmes are effective during war, and HIV networks should support implementing these initiatives, regardless of the local situation.…”

Hepatocellular carcinoma presentation and prognosis among Nigerian adults with and without HIV

“…Our study is one of the first to confirm active HCV infection with molecular testing in West Africa in persons with HCC. The prevalence of HCV among persons in this study far exceeds the national prevalence in the general population (1.73%) [ 3 ], suggesting HCV is an important risk factor for HCC in this region. In Europe and North America, HCV contributes to 30–60% cases of HCC countries [ 35 – 37 ] and is a leading indication for liver transplant in persons with HIV [ 38 ].…”

“…HCC is emerging as an increasing cause of mortality in persons with HIV (PLH) with increased access to antiretroviral therapy (ART) [ 3 , 4 ]. In the US, PLH have been shown to have a 3–7 times higher incidence of HCC compared to those without HIV [ 5 ].…”

Etiology of Persistent Microalbuminuria in Nigeria (P_MICRO study): protocol and study design

“…However, little is known about the prevalence and impact of CMV in Nigeria. The estimated prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) is 7.6% and 1.7%, respectively, among Nigerian adults (15–64 years of age) [ 74 ]. Various forms of kidney injury have been described in relation to HBV, including membranous nephropathy, membranoproliferative glomerulonephritis, and polyarteritis nodosa [ 69 , 75 ].…”